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HCPCS J2260 · Level II · Part B drug

HCPCS J2260: Injection, milrinone lactate, 5 mg

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: ASP payment limits October 2026 (effective October 1, 2026); MUE and NCCI edits 2026 Q4 (effective October 1, 2026); OPPS Addendum B July 2026 (effective July 1, 2026). Next CMS release: January 1, 2027 (ASP, MUE, NCCI and OPPS quarterly updates).

Key facts for J2260

Billing unit
5 MG
Inj milrinone lactate / 5 mg
ASP payment limit
$1.143
October 2026; +4.1% vs July 2026
Practitioner MUE
4
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J2260 is the Level II code for Injection, milrinone lactate, 5 mg, billed per 5 MG. The Medicare Part B ASP payment limit for October 2026 is $1.143 per billing unit, up 4.1% from July 2026. The practitioner MUE allows up to 4 units per date of service (MAI 3). Under OPPS it carries status indicator N. J2260 is billed in units of 5 MG; the quantity administered, the NDC package and the units on the claim must reconcile, which is the check that prevents CARC 16 and 151 returns on this line. The ASP crosswalk maps 35 NDCs to it, sold as Milrinone Lactate, Milrinone In Dextrose, Milrinone Lactate In Dextrose by Hikma Pharmaceuticals USA Inc., Baxter Healthcare Corporation, Pfizer Inc. No current Billing and Coding Article lists J2260, so coverage follows the FDA label, compendia and any applicable NCD.

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J2260 at $1.143 per 5 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $1.098 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J2260
QuarterPayment limitPerCoinsurance
October 2026$1.1435 MG20%
July 2026$1.0985 MG—
Source: CMS Medicare Part B Drug Payment Limit File. Commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 35 NDCs from 10 labelers to J2260. Report the NDC in the claim's drug segment and bill the number of J2260 units that equals the quantity administered divided by 5 MG; the last column gives units per full package.

NDCs that crosswalk to J2260
NDCDrug nameLabelerPackage sizeBilling units / package
00143-9326-10Milrinone LactateHikma Pharmaceuticals USA Inc.20 × 1040
00143-9373-10Milrinone LactateHikma Pharmaceuticals USA Inc.10 × 1020
00143-9374-10Milrinone LactateHikma Pharmaceuticals USA Inc.20 × 1040
00143-9708-01Milrinone LactateHikma Pharmaceuticals USA Inc.50 × 110
00143-9709-10Milrinone LactateHikma Pharmaceuticals USA Inc.20 × 1040
00143-9710-10Milrinone LactateHikma Pharmaceuticals USA Inc.10 × 1020
00143-9718-10Milrinone In DextroseHikma Pharmaceuticals USA Inc.200 × 1080
00143-9719-10Milrinone In DextroseHikma Pharmaceuticals USA Inc.100 × 1040
00338-6010-48Milrinone In DextroseBaxter Healthcare Corporation100 × 14
00338-6011-37Milrinone In DextroseBaxter Healthcare Corporation200 × 18
00409-0212-01Milrinone LactatePfizer Inc10 × 1020
00409-0212-02Milrinone LactatePfizer Inc20 × 1040
00409-0212-03Milrinone LactatePfizer Inc50 × 110
00409-2045-10Milrinone In DextrosePfizer Inc100 × 1040
25021-0313-82Milrinone In DextroseSagent Pharmaceuticals100 × 1040
25021-0313-87Milrinone In DextroseSagent Pharmaceuticals200 × 1080
55150-0287-10Milrinone In DextroseEugia US LLC100 × 1040
55150-0288-10Milrinone In DextroseEugia US LLC200 × 1080
63323-0617-10Milrinone LactateFreseniUS Kabi USA, LLC10 × 1020
63323-0617-20Milrinone LactateFreseniUS Kabi USA, LLC20 × 1040
63323-0617-50Milrinone LactateFreseniUS Kabi USA, LLC50 × 110
65145-0121-10Milrinone LactateCaplin Steriles USA Inc.20 × 1040
65145-0122-01Milrinone LactateCaplin Steriles USA Inc.50 × 110
65145-0176-10Milrinone LactateCaplin Steriles USA Inc.100 × 1040
70069-0807-10Milrinone LactateSomerset Pharma, LLC10 × 1020
70069-0808-10Milrinone LactateSomerset Pharma, LLC20 × 1040
70069-0809-01Milrinone LactateSomerset Pharma, LLC50 × 110
70069-0872-10Milrinone Lactate In DextroseSomerset Pharma, LLC100 × 1040
70069-0873-10Milrinone Lactate In DextroseSomerset Pharma, LLC200 × 1080
71288-0200-11Milrinone LactateMeitheal Pharmaceuticals Inc.10 × 1020
71288-0200-21Milrinone LactateMeitheal Pharmaceuticals Inc.20 × 1040
71288-0200-50Milrinone LactateMeitheal Pharmaceuticals Inc.50 × 110
72485-0501-10Milrinone LactateArmas Pharmaceuticals Inc.10 × 1020
72485-0502-10Milrinone LactateArmas Pharmaceuticals Inc.20 × 1040
72485-0503-01Milrinone LactateArmas Pharmaceuticals Inc.50 × 110

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J2260. For practitioners the limit is 4 units per date of service with adjudication indicator 3, a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation that the quantity was medically reasonable.

MUE values for J2260 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services43 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital163 Date of Service Edit: ClinicalClinical: Data
DME supplier2523 Date of Service Edit: ClinicalClinical: Data

NCCI edits and add-on relationships

No active practitioner PTP pair lists J2260 as a column-1 or column-2 code in v323r0. Drug supply codes are rarely bundled; the administration codes billed with them are where PTP edits usually apply.

J2260 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

No current Billing and Coding Article lists J2260 in its HCPCS table. Coverage then follows the drug's FDA label, compendia and any National Coverage Determination; check the Medicare Coverage Database before administering off-label.

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J2260 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J2260 and how to prevent them

CARC 16 · M119

NDC missing, invalid or not matched to the HCPCS code

CARC 151 · N362

units billed exceed the MUE for the date of service

CARC 50 · N115

diagnosis not covered by the applicable coverage article or LCD

How QuickIntell checks J2260 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current ASP crosswalk, checks units against every published MUE setting and flags PTP and add-on conflicts on the same claim. QuickRCM routes CARC 16, 151 and 50 denials on drug lines with the matching coverage article attached so the appeal starts with evidence.

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Frequently asked questions — HCPCS J2260

What does HCPCS code J2260 describe?

J2260 is defined by CMS as "Injection, milrinone lactate, 5 mg". Each billing unit represents 5 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J2260 in October 2026?

The ASP-based payment limit is $1.143 per 5 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $1.098.

How many units of J2260 can be billed per day?

The practitioner Medically Unlikely Edit is 4 units per date of service with adjudication indicator 3 (3 Date of Service Edit: Clinical). MAI 3 edits can be appealed with documentation that the units were medically reasonable. CMS cites "Clinical: Data" as the rationale.

Which NDCs map to J2260?

The October 2026 ASP crosswalk lists 35 NDCs from 10 labelers: Milrinone Lactate (Hikma Pharmaceuticals USA Inc.); Milrinone In Dextrose (Hikma Pharmaceuticals USA Inc.); Milrinone In Dextrose (Baxter Healthcare Corporation); Milrinone Lactate (Pfizer Inc). For example NDC 00143-9326-10 is a 20 package equal to 40 billing units. The crosswalk's billing-units-per-package figure converts each package into J2260 units.

Does J2260 have NCCI bundling edits?

No active practitioner PTP pairs list J2260 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. Verify against the primary file before billing or contracting decisions.

Disclaimer

This page is an operational reference compiled from CMS publications: the Medicare Part B drug payment limit and NDC crosswalk files, NCCI MUE and add-on edit tables, aggregate PTP statistics, OPPS Addendum B and the Medicare Coverage Database. Payment limits are Medicare national amounts; commercial and Medicaid payers differ. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.